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| CASE REPORT |
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| Year : 2018 | Volume
: 24
| Issue : 2 | Page : 123-124 |
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The inferior “transposition flap” in meatal nevus
Manish Munjal, Archana Arora, Amanjeet Singh, Porshia Rishi
Department of ENT and HNS, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| Date of Web Publication | 4-Sep-2018 |
Correspondence Address:
Dr. Archana Arora
Department of ENT and HNS, Dayanand Medical College and Hospital, 159-C, Rishi Nagar, Ludhiana - 141 001, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/indianjotol.INDIANJOTOL_111_17
Nevi and benign lesions of the epithelium of the cartilaginous meatus and refractory to multiple sessions of laser resections are ideal candidates for composite resection with transposition flap reconstitution, retaining thereby the esthetic appearance and dimensional configuration of the cartilaginous meatus. An inferiorly based flap transposed anteriorly and utilized in nevus of the floor and posterior wall gave excellent results.
Keywords: Meatal nevus, melanocytic nevi, transposition flap
How to cite this article:
Munjal M, Arora A, Singh A, Rishi P. The inferior “transposition flap” in meatal nevus. Indian J Otol 2018;24:123-4 |
| Introduction | |  |
Melanocytic nevi are common pigmented skin tumors, which can occur at any site; however, occurrence at the external auditory canal is rare. They may or may not be symptomatic but when associated with symptoms, it needs to be removed. This is a difficult site for surgery considering the risk of late canal stenosis. Various treatment options have thus been used.[1]
| Case Report | | |
A 45-year-old male had a bluish-black sessile lesion on the inferior wall of the left ear canal [Figure 1]. The lesions in clusters had an irregular surface and were raised above the surrounding skin. The area had been subjected to multiple sittings of laser applications in the past 2 years but was futile. Dermabrasion too had been unsuccessful.
He was therefore taken up for composite tissue resection, wherein the affected area, spanning about a 1 cm × 0.5 cm was marked out. Three postauricular and one preauricular, local anesthetic blocks of xylocaine 2% with adrenaline, 1 in 100,000 were administered, and with the number 11 lancet-shaped blade, the lesion was resected. Resection initiated from the canal side and included the skin and the underlying cartilage, leaving behind the unaffected skin of cranial side of the auricle. Hemostatic field attained using adrenaline saline patties with minimal cautery fulguration. An inferiorly based pedicled transposition flap was lifted from the postauricular region and was brought anteriorly through a tunnel. The edges of the flap were trimmed to align the surgical defect. Suturing with fine 5/0 ethilon of the anterior and posterior incision sites was carried out [Figure 2]. The skin on either side of the transposition flap was undermined, creating thereby advancement flaps to finally approximate under minimal tension. Extreme caution was taken to avoid exposure of the cartilage of the pinna, the most vulnerable to late perichondritis. The sutured edges were further kept apposed and the cartilaginous meatus kept dilated by inserting an inflatable antibiotic soaked Pope Ear wick. Ciprofloxacin with dexamethasone ear drops were instilled twice a day locally, oral anaerobic and aerobic coverage, along with anti-inflammatory medications was prescribed. Stitches were removed on day 7, and he had a smooth ear canal with a well-vascularized flap. It was planned to resect and reposition the lower end of the flap after 3weeks [Figure 3]. | Figure 2: (a) Flap after suturing (b) healed flap at 3 weeks postoperative
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| Discussion | | |
Melanocytic nevi are common pigmented benign skin tumors formed by proliferation of melanocytes from the dermoepidermal junction. Its occurrence near the external auditory canal is quite rare. When present, nevi usually give symptoms of aural fullness, conductive hearing loss, repeated attacks of acute otitis externa, or can be simply found as asymptomatic lesion on routine otoscopy. When symptomatic, it needs to be removed. It may simply be removed with excision biopsy through the transcanal approach. A skin graft is required after a wide surgical excision to cover up the defect. As the skin of the ear canal is thin and taut, CO2 lasers can be used as a good alternative.[1],[2]
Leaving the area after excision bare may lead to granulation tissue formation which leads to recurrent ear discharge. Circumferential canal wall defects may lead onto canal stenosis. Hence, to avoid this, skin grafts and flaps are of use.[3]
The defects following resection of the lesion are reconstructed using direct sutures, split-skin grafts, transposition flaps, or left as such for healing by secondary intention. The local flaps provide a very good color and texture match for the defect. Furthermore, it is well vascularized and has a good consistency.[4],[5]
The differential diagnosis should include inflammatory polyp, encephaloceles, foreign body granuloma viral wart, seborrheic keratosis, foreign body granuloma, and a variety of benign and malignant neoplasms.[1]
| Conclusion | | |
Meatal nevi are a rare occurrence which warrants removal if symptomatic or for esthetic reasons. Reconstruction after the removal of large lesions can be done using direct sutures, split-skin grafts, or transposition flaps. Flaps offer good color match postreconstruction and are thus a better option.
Consent
Informed consent was taken from all the participants.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Kim WS, Park KH. Compound nevus occurring near external auditory canal: Successful treatment by CO2 laser abrasion. Korean J Audiol 2013;17:30-1.  |
| 2. | Alves RV, Brandão FH, Aquino JE, Carvalho MR, Giancoli SM, Younes EA, et al. Intradermal melanocytic nevus of the external auditory canal. Braz J Otorhinolaryngol 2005;71:104-6. |
| 3. | Bakshi J, Yadav S, Kumar A. An intradermal nevus of the external auditory canal – A rare occurrence. Ann Otolaryngol Rhinol 2017;4:1181. |
| 4. | Sánchez-Sambucety P, Alonso-Alonso T, Rodríguez-Prieto MA. Tunnelized preauricular transposition flap for reconstruction of anterior auricular defects. Actas Dermosifiliogr 2008;99:161-2. |
| 5. | Pereira N, Brinca A, Vieira R, Figueiredo A. Tunnelized preauricular transposition flap for reconstruction of auricular defect. J Dermatolog Treat 2014;25:441-3. |
[Figure 1], [Figure 2], [Figure 3]
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